A Direct Experience in a New Accountable Care Organization: Results, Challenges, and the Role of the Neurosurgeon

Abstract

The passage of the Affordable Care Act saw the creation of Accountable Care Organizations (ACOs), a new approach to healthcare delivery moving from fee-for-service toward population health. This paper presents a case study of the Memorial Hermann ACO (MHACO), launched in response to the Medicare Shared Savings Program, with goals to align physician and hospital incentives, practice evidence-based medicine, develop care coordination, and increase efficiency. Building blocks included an affiliated primary care network, a clinical integration program (involving shared electronic medical record platforms and quality data reporting), and significant investments in information technology. Presented is the approach taken to form MHACO; the management structure, technology developed, and a 2-year experience. Incorporated in July 2012, the MHACO involved 22 000 Medicare patients. In 2015, Centers for Medicare and Medicaid Services released data showing a composite quality score between 80 and 85 (from a maximum 100) and nearly $53 million in total savings (or 11% of expected expenditure), making MHACO one of the most successful nationally.1 In fewer than 5 years, almost 500 ACOs have developed, and by some estimates, a quarter of Medicare patients are currently enrolled in an ACO. Although ACOs to date have focused on primary care, the future will increasingly involve specialists. At Memorial Hermann, neurosurgeons took an early role in forming collaborative partnerships with the hospital, and started programs that served as precursors to the ACO model. This paper ends with an overview of ACO development, likely changes going forward, and a discussion of the role of specialists in general, and of neurosurgeons in particular.

Effects of Health Care Payment Models on Physician Practice in the United States: Follow-Up Study

“…Internally, as in our 2014 study, key orga nizational priorities of ACOs have been trans forming primary care practices (Harris, Elizondo, and Brown, 2016) and strengthening care management and the engagement of allied health professionals (Shortell et al, 2014;Baloh et al, 2015;Pittman and Forrest, 2015;D'Aunno et al, 2016). Other more recent internal orga nizational trends include developing clinical integration tools across partners (e.g., shared medical rec ords) (Kim et al, 2017), improving care transitions (Hacker et al, 2014), and qual ity improvement activities (Balasubramanian et al, 2018). In the early phases of implemen tation, there has been relatively little emphasis on standardization of care delivery pro cesses across practices (Lewis et al, 2016).…”

“…The motivations for forming such partnerships included resource complementarity and risk spreading (Lewis et al, 2017). In developing partnerships, ACOs have tended to emphasize building an affili ated primary care network, with less attention to engaging specialists or other types of health care delivery organ izations, such as post acute care or hospice (Kuramoto, 2014;Colla, Lewis, Berquist, et al, 2016;Driessen and West, 2017;Driessen and Zhang, 2017;Kim et al, 2017;McWilliams et al, 2017;Res nick et al, 2018). The majority of existing ACO partner ships are based on preexisting positive relationships, but a minority involve organ izations that were previously in competition (Lewis et al, 2017).…”

Procedural Trends in Medicare Reimbursement and Utilization for Breast Reconstruction

“…31 One example is the Accountable Care Organization (ACO), introduced as part of the Affordable Care Act of 2010. 32 Advantages of ACOs include mass participation that facilitates gainsharing and increased physician reimbursement for reaching specific patient outcome measures. However, utilization of ACOs has been limited by insufficient gain-sharing potential and difficulty in defining measurable outcomes.…”

“…Several strategies have been proposed, the majority of which target high-value care that aims to improve clinical outcomes and reduce costs 31 . One example is the Accountable Care Organization (ACO), introduced as part of the Affordable Care Act of 2010 32 . Advantages of ACOs include mass participation that facilitates gain-sharing and increased physician reimbursement for reaching specific patient outcome measures.…”